Hormone replacement therapy in morphine-induced hypogonadic male chronic pain patients

Abstract

BackgroundIn male patients suffering from chronic pain, opioid administration induces severe hypogonadism, leading to impaired physical and psychological conditions such as fatigue, anaemia and depression. Hormone replacement therapy is rarely considered for these hypogonadic patients, notwithstanding the various pharmacological solutions available.MethodsTo treat hypogonadism and to evaluate the consequent endocrine, physical and psychological changes in male chronic pain patients treated with morphine (epidural route), we tested the administration of testosterone via a gel formulation for one year. Hormonal (total testosterone, estradiol, free testosterone, DHT, cortisol), pain (VAS and other pain questionnaires), andrological (Ageing Males' Symptoms Scale - AMS) and psychological (POMS, CES-D and SF-36) parameters were evaluated at baseline (T0) and after 3, 6 and 12 months (T3, T6, T12 respectively).ResultsThe daily administration of testosterone increased total and free testosterone and DHT at T3, and the levels remained high until T12. Pain rating indexes (QUID) progressively improved from T3 to T12 while the other pain parameters (VAS, Area%) remained unchanged. The AMS sexual dimension and SF-36 Mental Index displayed a significant improvement over time.ConclusionsIn conclusion, our results suggest that a constant, long-term supply of testosterone can induce a general improvement of the male chronic pain patient's quality of life, an important clinical aspect of pain management.

Effects of gonadal hormones on the peripheral cannabinoid receptor 1 (CB1R) system under a myositis condition in rats

“…Nevertheless, the present observations suggest that testosterone, but not estradiol, is required in the upregulation of peripheral CB1R under inflammatory conditions. A testosterone deficiency has been reported in chronic pain patients, and testosterone replacement therapy is necessary for satisfactory pain control [3]. Our data suggest that testosterone may be involved in maintaining endogenous antinociceptive systems such as CBR in chronic pain conditions and that effective treatment strategies targeting peripheral CB1R should consider the hormonal status of patients.…”

Androgen receptor transcriptionally regulates μ-opioid receptor expression in rat trigeminal ganglia

“…Epidemiological data show that testosterone levels decline with normal aging (Harman et al, 2001; Feldman et al, 2002), which could lead to reduced opioid efficacy. Recent clinical studies provide compelling evidence that testosterone therapy enhances pain management in elderly men and hypogonadic chronic pain patients (Aloisi et al, 2011; Dedov et al, 2011; Tan et al, 2013). Clinically, low testosterone levels have been linked to various disease states such as diabetes and ischemic heart disease (Barrett-Connor and Khaw, 1988; Barrett-Connor, 1992).…”

Testosterone Replacement Therapy Outcomes Among Opioid Users: The Testim Registry in the United States (TRiUS)

“…In one study, 16 men with OPIAD who completed 24 weeks of treatment with testosterone patch therapy experienced improvements in mood/depression and sexual function outcomes [12]. More recently, a study of 17 men with OPIAD and who were receiving epidural morphine for chronic noncancer pain found that TRT (testosterone gel) for up to 12 months was associated with improved sexual function [29]. However, these studies had a limited number of patients, and because they did not include any patients who were not opioid users, potential differences in outcomes between opioid users and nonusers could not be evaluated.…”